Form Soc 501 - Levels Of Care (Loc) Rate Determination Matrix printable pdf download

Levels of Care (LOC) Rate Determination Matrix

Definition

Core Domain

Physical

Physical Domain is defined as actions in which the Resource Family must engage in or model daily living needs, such as eating, clothing, hygiene, community/social functioning, and

extracurricular activities, including teaching age-appropriate life skills even when developmental delays are present. This does not include specific medical activities (see Health Domain).

Expectations

Resource Family provides

Resource Family implements and monitors

Resource Family provides supervision, verbal cueing,

healthy meals,

supervision, verbal cueing

supervision, verbal cueing and/or

a plan of supervision, verbal cueing and/or

and/or direct physical assistance in at least 6

opportunities for daily

and/or physical assistance

direct physical assistance in at least

direct physical assistance in at least 3

ADLs/IADLs beyond what is age/developmentally

activity, predictable sleep

for at least 1 ADL/IADL

2 different ADLs /IADLs beyond

different ADLs/IADLs beyond what is

appropriate on a daily basis.

routine, and

beyond what is

what is age/developmentally

age/developmentally appropriate on a daily

developmentally

age/developmentally

appropriate on a daily basis.

basis.

And/or

appropriate support for

appropriate on a daily

Resource Family arranges and/or facilitates

physical hygiene.

basis.

And/or

participation in developmental, physical and/or

Resource Family arranges and/or

Resource Family arranges and/or facilitates

occupational therapy on average at least 6 or more

And/or

facilities participation in

participation in developmental, physical

times monthly.

Resource Family provides

Resource Family arranges

developmental, physical and/or

and/or occupational therapy on average at

support to assist the youth

and/or facilitates

occupational therapy on average up

least 4 or more times monthly.

And/or

in developing life skills that

participation in

to 3 times per month.

Resource Family provides the child constant

are age/developmentally

developmental needs, i.e.,

And/or

supervision to enable the child to participate in

appropriate.

physical and/or

And/or

Resource Family accompanies the child

community/extracurricular activities.

occupational therapy no

Resource Family must do check-in

and/or provides direct support to enable the

more than once per month.

with community/extracurricular

child to participate in

activities to ensure continuity of

community/extracurricular activities.

ADL/IADL routines.

Points

Additional

● Activities of Daily Living (ADLs) include: Transferring (i.e., walking and/or moving from place to place), use of upper extremities (hand, arms, fingers), bathing, grooming, menstrual care,

Information

dressing, feeding and/or toileting including enuresis/encopresis.

Instrumental Activities of Daily Living (IADLs) include: managing finances, accessing transportation, shopping, preparing meals, using communication devices, managing medications and/or

completing basic housework. IADLs apply to youth 14 years of age and older for purposes of the Level of Care.

● If the minor/nonminor dependent (NMD) is pregnant or parenting, consider the Infant Supplement. The Resource Family may need to provide supports to the minor/NMD in preparing for

parenthood and/or in parenting their child.

SOC 501 (12/17)

Form Soc 501 - Levels Of Care (Loc) Rate Determination Matrix

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